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Intimate Partner Violence and Family Planning: Opportunities for Action

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Intimate Partner Violence and Family Planning: Opportunities for Action Policy Brief JULY 2015 BY KATE GILLES INTIMATE PARTNER VIOLENCE AND FAMILY PLANNING: OPPORTUNITIES FOR ACTION Intimate partner violence (IPV)—physical and/or BOX 1 sexual violence by a current or former partner—is an issue that women in all regions and all countries experience (see definition, Box 1).1 Globally, DefiningIntimate 1 in 3 approximately one in three women who have ever Partner Violence (IPV) The share of women been in a relationship have experienced IPV.2 worldwide who have Women face a greater risk of violence from an Intimate partner violence (IPV) refers to physical experienced intimate 3 and/or sexual violence by a current or former partner violence. intimate partner than from anyone else. partner. Physical and sexual violence often This brief presents data to help policymakers and occur together, though not always, and can others understand the nature and extent of the happen in the context of marriage or less formal relationships (including dating or unmarried sexual harm caused by IPV, especially as it relates to relationships). IPV can affect men and women women’s reproductive health and autonomy, and Unintended pregnancy alike, but most frequently women experience is more common among highlights opportunities for action. Policymakers IPV at the hands of male partners. women who have can combat IPV and its consequences by experienced intimate promoting integrated policies and dedicating Source: World Health Organization (WHO), Global and Regional partner violence financial resources to support systems, programs, Estimates of Violence Against Women: Prevalence and Health Effects compared to those of Intimate Partner Violence and Non-Partner Sexual Violence (Geneva: and services to address the intersection of IPV, WHO, 2013); and WHO, Preventing Intimate Partner and Sexual who have not. health, and women’s empowerment. Violence Against Women: Taking Action and Generating Evidence (Geneva: WHO, 2010). Intimate Partner Violence Is a Global Epidemic FIGURE 1 2X Higher The highest rates of IPV are found in Africa, the IPV Occurs Among Women of All Ages The difference in induced eastern Mediterranean, and Southeast Asia— abortion rates between approximately 37 percent of women in each Percent of Ever-Partnered Women Who Have Experienced IPV women who have of those regions, compared to 23 percent in 37.8 experienced intimate high-income regions.4 Some women may be 36.6 partner violence and especially vulnerable to IPV and the associated 32.3 those who have not. 31.6 31.1 negative consequences, including young women 29.4 29.2 and women in crisis or conflict settings (see Figure 1; see Box 2).5 Other factors that increase a woman’s risk of IPV include early marriage, partner’s alcohol abuse, and witnessing domestic violence as a child.6 IPV imposes significant health and rights consequences on women, including poor physical, mental, and reproductive health, and on their infants and children, who are at greater risk for a variety of poor health and development 15–19 20–24 25–29 30–34 35–39 40–44 45–49 outcomes. The negative effects of IPV extend to Age national development that is hampered by lost Sources: World Health Organization (WHO), Global and Regional Estimates of Violence Against Women: Prevalence and Health Effects of Intimate productivity and increased health and other social Partner Violence and Non-Partner Sexual Violence (Geneva: WHO, 2013). services costs. BOX 2 BOX 3 IPV Among Adolescent Girls Addressing IPV Within a and Young Women Rights-Based Approach to IPV is a common experience among adolescent girls and young Reproductive Health women. Among those who have ever been in a relationship, 29 percent of 15-to-19-year-old girls and 32 percent of The growing emphasis on a rights-based approach to 20-to-24-year-old young women have experienced physical reproductive health care promotion and provision presents or sexual violence from a partner. These figures are especially a key opportunity to address the negative impact of IPV. It is alarming since early sexual and relationship experiences a violation of multiple human rights, including the right to life are a significant influence on a woman’s future: The effects and security of the person, the right to equality, and the right 1 of violence during this formative period on a woman’s long- to the highest attainable standard of health. A rights-based term health and well-being may be magnified. Since women approach to family planning and reproductive health accounts who experience one instance of partner violence are likely to for the full range of barriers that may interfere with a woman’s experience more, violence at a young age may increase ability to make free, informed, and voluntary decisions about a woman’s overall lifetime exposure.1 her reproductive health and behavior, including contraceptive use.2 Seen through this lens, addressing IPV is a strategy for Adolescent girls and young women may be at heightened enabling otherwise disempowered women to gain some control risk for IPV because of their youth, relative inexperience, and over one aspect of their lives. gendered power dynamics, especially if the male partner is 1 World Health Organization (WHO), Responding to Intimate Partner Violence and 2 older. Though IPV frequently occurs outside of marriage, early Sexual Violence Against Women: WHO Clinical and Policy Guidelines (Geneva: marriage is a particular risk factor. WHO, 2013). 1 Heidi Stöckl et al., “Intimate Partner Violence Among Adolescents and Young 2 Family Planning 2020, “Rights and Empowerment Principles for Family Planning,” Women: Prevalence and Associated Factors in Nine Countries, A Cross-Sectional (2014), accessed at www.familyplanning2020.org/resources/4697 on May 20, 2015. Study,” BMC Public Health 14, no. 751 (2014); Michelle Decker et al., “Gender- Based Violence Against Adolescent and Young Adult Women in Low- and Middle- Income Countries,” Journal of Adolescent Health 56 (2015): 188-96; and World Health Organization (WHO), Global and Regional Estimates of Violence Against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence (Geneva: WHO, 2013). and a violation of human rights (see Box 3).9 Increasingly, IPV is 2 WHO, Preventing Intimate Partner and Sexual Violence Against Women: Taking also being recognized as a health issue, especially reproductive Action and Generating Evidence (Geneva: WHO, 2010). health.10 Awareness is still limited regarding the relationship between IPV and reproductive health and the appropriate role of policymakers and health care providers in identifying, responding to, and supporting women experiencing IPV. Some of the most severe consequences of IPV are related to women’s reproductive health and empowerment. These outcomes include higher rates of unplanned pregnancy, IPV: Wide-Ranging Consequences abortion, and miscarriage, suggesting that IPV often interferes Women who experience IPV are at greater risk of a range of poor with women’s ability to consistently use effective contraception. health conditions and outcomes (see Figure 2, page 3 ). They are twice as likely to experience depression as women who have not Bringing IPV Into the Open experienced IPV, and up to one and a half times more likely to become HIV positive.11 Other negative health outcomes include IPV is often treated as a private matter, ignored, or even seen injury, gastrointestinal problems, chronic pain, depression, as normal or acceptable. Frequently, women do not report posttraumatic stress disorder, suicide, and alcohol use.12 abuse by an intimate partner out of fear of retaliation or stigma, the belief that violence from partners is expected, or the feeling IPV also has serious consequences for infants and children: that no one can or will help them.7 Violent behavior in general Women in violent relationships are less likely to receive and violence towards a partner in particular are often seen as adequate prenatal care and more likely to have a preterm normal, acceptable masculine behaviors. These attitudes are birth or low birth-weight baby. Children of women who learned early on, and boys and girls who witness household experience IPV are less likely to receive immunizations and abuse often carry those behaviors into the next generation.8 may be at increased risk of additional health, developmental, and behavioral problems later in life.13 Moreover, children who Only within the past few decades has IPV (along with other witness violence in their home are significantly more likely to types of violence against women) come to be seen as a crime perpetrate or experience violence themselves later in life.14 2 www.prb.org INTIMATE PARTNER VIOLENCE AND FAMILY PLANNING: OPPORTUNITIES FOR ACTION HIV and other sexually transmitted infections (STIs), or insist on FIGURE 2 contraception.18 IPV is sometimes accompanied by reproductive Pathways and Health Effects of Intimate Partner Violence coercion, in which a male partner directly interferes with a woman’s desires for her pregnancy (see Box 4).19 The controlling INTIMATE PARTNER VIOLENCE behavior that often characterizes violent relationships can constrain a woman’s access to health care, including family FEAR AND planning, and exacerbate health problems associated with IPV.20 CONTROL Women who experience IPV also experience higher rates LIMITED SEXUAL HEALTH CARE of unintended pregnancy.21 A study in Colombia estimated AND REPRODUCTIVE SEEKING that stopping IPV in that country would prevent over 32,000 CONTROL • lack of autonomy
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